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92 Cards in this Set
- Front
- Back
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Pheochromocytoma: most secrete what? (3)
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epinephrine
NE dopamine |
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Pheochromocytoma: what substances are elevated?
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VMA in urine
catecholamines in plasma |
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Pheochromocytoma: associated with what syndrome(s)?
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MEN II and III
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Pheochromocytoma: treatment and its mechanism?
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alpha-antagonists: Phenoxybenzamine is a nonselective, IRREVERSIBLE alpha blocker
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Pheochromocytoma: types of symptoms?
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Episodic hyperadrenergic symptoms (5 P's):
1. Pressure 2. Pain (headache) 3. Perspiration (tachycardia) 4. Palpitations 5. Pallor |
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Pheochromocytoma: Rule of 10's?
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10% malignant
10% bilateral 10% extra-adrenal 10% calcify 10% kids 10% familial |
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Pheochromocytoma: typical presentation of symptoms in general?
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"spells" - relapse and remit
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MEN I: aka?
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Wermer's Syndrome
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MEN I: affects what organs?
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3 "P" organs:
1. Pancreas - ZE syndrome, insulinomas, VIPomas 2. Pituitary - prolactinomas 3. Parathyroid |
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MEN I: how does it present?
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kidney stones and stomach ulcers
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MEN: inheritance patterns of all forms?
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autosomal dominant
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MEN II: aka?
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Sipple's syndrome
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MEN II: presentation?
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1. medullary carcinoma of the thyroid
2. pheochromocytoma 3. parathyroid tumor |
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MEN III: presentation?
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1. medullary carcinoma of the thyroid
2. pheochromocytoma 3. oral and intestinal ganglioneuromatosis (mucosal neuromas) |
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MEN: gene assoc. w/ types II and III?
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ret gene
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Hypothyroidism: symptoms?
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cold intolerance
hypoactivity weight gain fatigue lethargy dec appetite constipation weakness dec reflexes myxedema (facial/periorbital) dry, cool skin coarse, brittle hair |
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D/Dx: cold intolerance, hypoactivity, weight gain, fatigue, lethargy, dec appetite, constipation, weakness, dec reflexes, myxedema (facial/periorbital); dry, cool skin; coarse, brittle hair
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hypothyroidism
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Hypothyroidism: labs?
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high TSH (sensitive test for primary hypothyroidism)
low total T4 low free T4 low T3 uptake |
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Hyperthyroidism: symptoms?
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heat intolerance
hyperactivity weight loss chest pain/palpitations arrhythmias diarrhea inc refexes warm moist skin fine hair |
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D/Dx: heat intolerance, hyperactivity, weight loss, chest pain/palpitations, arrhythmias, diarrhea, inc refexes, warm, moist skin, fine hair
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hyperthyroidism
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Hyperthyroidism: labs?
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low TSH (if primary)
high total T4 high free T4 high T3 uptake |
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What is Reidel's thyroiditis? What does it cause?
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thyroid replaced by fibrous tissue
causes hypothyroidism |
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Grave's dz: cause?
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autoimmune hyperthyroidism w/ thyroid-stimulating/TSH receptor antibodies
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Grave's dz: symptoms?
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ophthalmopathy (proptosis, EOM swelling)
pretibial myxedema diffuse goiter |
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D/Dx: ophthalmopathy (proptosis, EOM swelling), pretibial myxedema, diffuse goiter
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Grave's dz
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What type of hypersensitivity is Graves' dz?
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type II
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Common time for Graves' dz to present?
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during stress (i.e. childbirth)
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What is thyroid storm?
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underlying Graves' dz w/ a stress-induced catecholamine surge --> may cause death
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Hashimoto's thyroiditis: cause?
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autoimmune disease causing hypothyroidism
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Hashimoto's thyroiditis: may occur due to what?
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follicular rupture w/ thyrotoxicosis
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Hashimoto's: clinical presentation?
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slow course
moderately enlarged, nontender thyroid |
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Hashimoto's: histo? associated cell type?
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lymphocytic infiltrates w/ germinal centers
Hurthle cells |
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Hashimoto's: what antibodies?
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antimicrosomal antibodies
antithyroglobulin antibodies |
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Subacute thyroiditis: aka?
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de Quervain's thyroiditis
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Subacute thyroiditis: what is it?
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self-limited hypothyroidism often following flulike illness
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Subacute thyroiditis: symptoms?
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elevated ESR
jaw pain early inflammation and very tender thyroid gland |
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D/Dx: elevated ESR, jaw pain, early inflammation and very tender thyroid gland
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Subacute thyroiditis
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Subacute thyroiditis: how may it present early in course?
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as hyperthyroid
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Toxic multinodular goiter: why do you get it?
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iodine deprivation followed by iodine restoration
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Toxic multinodular goiter: causes release of what?
are the nodules malignant? |
T3 and T4 released
nodules NOT malignant |
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Jod-Basedow phenomenon?
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assoc w/ Toxic multinodular goiter
=thyrotoxicosis if a patient w/ endemic goiter moves to iodine-replete area |
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Thyroid CA: five types?
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1. papillary carcinoma
2. follicular carcinoma 3. meduallary carcinoma 4. undifferentiated/anaplastic carcinoma 5. lymphoma |
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Papillary carcinoma description?
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most common thyroid CA
excellent prognosis "ground glass" nuclei (Orphan Annie eyes) psammoma bodies increased risk w/ childhood irradiation |
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D/Dx: most common thyroid CA, excellent prognosis, "ground glass" nuclei (Orphan Annie eyes), psammoma bodies, increased risk w/ childhood irradiation
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papillary thyroid carcinoma
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Follicular carcinoma:
prognosis? appearance? |
good prgnosis
uniform follicles |
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Medullary carcinoma:
from what cells? produce what? appearance? assoc with what syndromes? |
-from parafollicular "C cells"
-make calcitonin -look like sheets of cells in amyloid stroma -MEN II and III |
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Anaplastic/undifferentiated carcinoma of thyroid:
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older patients
very poor prognosis |
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Lymphoma: what thyroid issue is it associtaed with?
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associated with Hashimoto's thyroiditis
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Cretinism:
-when do endemic cases occur? -when do sporadic cases occur? |
Endemic cretinism cases occur wherever endemic goiter is prevalent (lack of dietary iodine).
Sporadic cretinism is due to a defect in T4 formation or developmental failure in thyroid formation. |
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Cretinism: findings?
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pot-bellied
pale puffy-faced child with prtruding umbilicus and protuberant tongue |
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Cretinism:
-what does cretin mean and why was it goven this name? -what part of the world is it still common in? |
Cretin means Christlike. Those affected were considered retarded as to be incapable of sinning. Still common in China.
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Acromegaly:
-due to? -if it occurs in kids? -medical treatment? |
Due to excess GH in adults. Is gigantism in kids (epipheses haven't yet closed).
Treat with octreotide. |
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Acromegaly: findings?
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Findings: large tongue w/ deep furrows, deep voice, large hands and feet, coarse facial features, impaired glucose tolerance (insulin resistant)
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When is it normal to have an increased GH level?
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stress
exercise hypoglycemia |
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Primary Hyperparathyroidism:
-usually due to? -serum findings? -what is high in urine? |
-Usually an adenoma.
-Serum findings: hypercalcemia, hypercalciuria (rena stones), hypophosphatemia, elevated PTH -eleveated cAMP in urine |
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Primary hyperparathyroidism:
-Presentation? |
"Stones, bones, and groans."
-bone pain: Osteitis fibrosa cystica (von Recklinghausen's syndrome) - cystic bone spaces fill with brown fibrous tissue --> bone pain May present with weakness and constipation ("groans"). "Stones" = kidney stones Often asymptomatic. |
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Secondary hyperparathyroidism:
-most often due to? -serum findings? |
Caused by secondary hyperplasia due to low Calcium. Most often in chronic renal disease.
Serum: hypocalcemia, hyperphosphatemia, elevated PTH |
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Secondary hyperparathyroidism:
-what bone problem is seen? |
Renal osteodystrophy - bone lesions due to secondary hyperparathyroidism due to renal disease.
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Hypoparathyroidism:
-findings? -due to? assoc with what syndrome? |
Hypocalcemia and tetany.
Due to accidental surgical removal (thyroid surgery) or Di George syndrome. |
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Hypoparathyroidism:
-Chvostek's sign? -Trousseau's sign? |
Chvostek's sign: tap facial nerve --> contraction of facial muscles
Trousseau's sign: occlusion of brachial artery with BP cuff --> carpal spasm |
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Pseudohypoparathyroidism:
-due to? -findings? |
due to autosomal-dominant kidney unresponsiveness to PTH
hypocalcemia, shortened 4th/5th digits, short stature |
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Hypercalcemia:
causes? (mneumonic) |
CHIMPANZEES:
-Calcium ingestion (milk-alkali syndrome) -Hyperparathyroid -Hyperthyroid -Iatrogenic (thiazides) -Multiple myeloma -Paget's disease -Addison's disease -Neoplasms -Zollinger-Ellison syndrome -Excess vitamin D -Excess vitamin A -Sarcoidosis |
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Pituitary adenoma:
-what type is most common? signs? |
Prolactinomas are most common: ammenorrhea, galactorrhea, low libido, infertility.
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Pituitary adenoma: treatment?
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Treatment: bromocriptine (dopamine agonist) causes shrinkage.
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Acute manifestations of diabetes mellitus?
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polydipsia
polyuria polyphagia weight loss DKA (type 1) hyperosmolar coma (type 2) unopposed secretion of GH and epinephrine (exacerbates hyperglycemia) |
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Chronic manifestations of diabetes mellitus:
-nonenzymatic glycosylation causes what? |
Nonenzymatic glycosylation:
1. small vessel disease (diffuse thickening of basement membrane) --> retinopathy, glaucoma, nephropathy 2. Large vessel atherosclerosis, CAD, peripheral vascular occlusive disease and gangrene, cerebrovascular disease |
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What causes retinopathy in DM?
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hemorrhage
exudates microaneurysms vessel proliferation |
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What's seen with nephropathy due to DM?
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-nodular sclerosis
-progressive proteinuria -chronic renal failure -arteriosclerosis leading to HTN -Kimmelstein-Wilson nodules |
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Chronic manifestations of diabetes mellitus:
-what problems are associated with osmotic damage? |
Osmotic damage:
1. neuropathy - motor, sensory, and autonomic degeneration 2. cataracts - sorbitol accumulation |
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Genetic predisposition for diabetes?
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type 1 - weak, polygenic
type 2 - strong, polygenic |
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Diabetes associated with HLA system?
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Type 1 is associated with HLA-DR3 and DR4.
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Which type of diabetes most often presents with classic symptoms (polyuria, polydipsia, thirst, weight loss)?
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more common presentation in Type 1, but does occur in Type 2
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What causes diabetic ketoacidosis?
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Usually due to an increase in insulin requirements from an increase in stress (i.e. infection).
Excess fat breakdown and increased ketogenesis from the increase in FFAs --> ketone bodies. |
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Signs/symptoms of DKA?
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-Kussmal respirations = rapid/deep breathing
-hyperthermia -nausea/vomiting -abdominal pain -psychsosis/dementia -dehydration -fruity breath odor: due to exhaled acetone |
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Labs in DKA?
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-hyperglycemia
-high H+ -low HCO3- (anion gap metabolic acidosis) -high blood ketone levels -leukocytosis -hyperkalemia (but depleted intracellular K+) |
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Complications of DKA?
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-life-threatening mucormycosis
-Rhizopus infection -cerebral edema -cardiac arrhythmias -heart failure |
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Treatment of DKA?
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fluids, insulin, and potassium
glucose if necessary to prevent hypoglycemia |
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What is diabetes insipidus?
Caused by? |
Characterized by intensive thirst and polyuria together with an inability to cncentrate urine due to:
1. lack of ADH (central DI) 2. lack of renal response to ADH (nephrogenic DI) |
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4 causes of central DI?
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1. pituitary tumor
2. trauma 3. surgery 4. histiocytosis X |
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4 causes of nephrogenic DI?
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1. hereditary
2. secondary to hypercalcemia 3. secondary to lithium 4. secondary to demeclocycline |
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How do you diagnose diabetes insipidus?
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Water deprivation test: urine osmolality does not increase.
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Findings in DI?
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-urine specific gravity <1.006
-serum osmolality >290 mOsm/L |
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Treatment of both types of DI?
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Adequate fluid intake.
1. central DI - intranasal desmopressin (ADH analog) 2. nephrogenic DI - HCTZ, indomethacin, or amiloride |
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SIADH: classic findings?
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1. excessive water retention
2. hyponatremia 3. urine osmolarity > serum osmolarity |
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SIADH: what problem can low serum sodium cause?
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low serum sodium can cause seizues (must correct slowly)
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SIADH: treat with?
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treat with demeclocycline or water restriction
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SIADH: causes?
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1. ectopic ADH (small cell lung cancer)
2. CNS disorders/head trauma 3. pulmonary disease 4. drugs (e.g. cyclophosphamide) |
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Carcinoid syndrome:
-what is it? -most common tumor of what organ? |
A rare syndrome caused by carcinoid tumors (neuroendocrine cells), especially metastatic small bowel tumors, which secrete high levels of 5-HT.
Most common tumor of the appendix. |
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Carcinoid syndrome:
-when is it NOT seen? -results in recurrence of what symptoms? |
NOT seen if tumor is limited to the GI trat (serotonin undergoes 1st pass metabolism in the liver)
Symptoms: diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease |
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Carcinoid tumor: what's present in the urine?
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high 5-HIAA in urine
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Carcinoid tumor:
-what is the rule of 1/2? -derived from what cells? -treat with? |
Rule of 1/3:
-1/3 metastasize -1/3 present with second malignancy -1/3 multiple -derived from neuroendocrine cells of GI tract -treat with octreotide |
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Zollinger-Ellison syndrome:
-what is it? -what does it cause? -may be associated with what syndrome? |
=gastrin-secreting tumor of pancreas or duodenum
-causes recurrent ulcers -may be associated with MEN I |
